Open Versus Minimally Invasive Emergent Colectomy for Diverticulitis

Area of Science:

• Colorectal Surgery
• Surgical Outcomes Research
• Gastrointestinal Surgery

Background:

• The optimal surgical approach for acute diverticulitis remains debated.
• Minimally invasive surgery (MIS) versus open colectomy outcomes require further investigation.

Purpose of the Study:

• To compare clinical and financial outcomes of MIS versus open colectomy for acute diverticulitis.
• To analyze outcomes in patients requiring conversion to open surgery.

Main Methods:

• Analysis of a national surgical database (2015-2020) for emergent colectomies in diverticulitis patients.
• Regression models to assess the association between surgical approach (open vs. MIS) and outcomes.
• Subgroup analysis for outcomes comparing open, MIS, and conversion to open (CTO) procedures.

Main Results:

• MIS colectomy was associated with reduced major adverse events (MAE), ostomy creation, and nonhome discharge compared to open surgery.
• MIS also resulted in a shorter postoperative length of stay (LOS).
• Conversion to open surgery (CTO) still demonstrated improved outcomes over planned open colectomy for MAE and ostomy creation.

Conclusions:

• Minimally invasive surgery (MIS) for acute diverticulitis colectomy is linked to superior clinical and financial results.
• Even when conversion to open surgery is necessary, MIS offers benefits.
• MIS should be considered the initial approach for emergent colectomy in diverticulitis.